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Aim: Both anticholinergic burden (ACB) and depression are known to
increase fall risk in older persons, next to increasing morbidity and
mortality. However, the effect of depression on fall risk associated
with ACB is unclear. This is relevant because most antidepressants have
anticholinergic effects. The aim of this study was to assess the
relationship between ACB and falls, and the impact of depression on this
relationship. Methods: We cross-sectionally examined the relationship
between both ACB and clinical depression and falls in the past 12
months, in a harmonized cohort of Dutch community dwelling persons
(n=7884). For all analyses, we calculated adjusted odds ratios (ORs) and
their 95% confidence intervals. We also investigated the impact of
depression on the relationship between ACB and falls, by calculating
interaction on both an additive and multiplicative scale. Results: Both
a high ACB score (≥3) and clinical depression were independently
significantly associated with falls in the past 12 months. Additionally,
there was a statistically significant interaction (p=0.038) between ACB
and clinical depression on fall risk, both on an additive and
multiplicative scale (1.13 and 1.44 respectively). Conclusion: In older
persons, the presence of clinical depression strengthened the
association between ACB and falls. We dissuade bluntly withholding
pharmacological treatment to avoid falls, despite the ACB of
antidepressants. In case of depression, we recommend considering
non-pharmacological alternatives; choose pharmacological interventions
with the lowest risk of adverse events; assess and treat other fall
risk-factors; and perform multidisciplinary a medication review to
minimize (accumulation of) ACB.</div>